Brian O'Riordan, Registrar
During Speech and Hearing month in May, CASLPO launched the first issue of our on-line e-Newsletter ex·press, replacing the hard-copy magazine, CASLPO Today. We switched to this new format in response to member input received in surveys throughout 2013 and 2014. The input we received about issue 1 indicates that members have responded positively to the new format and content. We will continue to review your feedback and make any necessary modifications as we move forward.
Thank you for your input. Continued Feedback: email@example.com
In this issue, you will find updates on changes made to increase Transparency, and articles on Practice Advice and Quality Assurance. There is also an important reminder about renewing your annual membership for 2015-16. As well, as a result of College Council elections this spring, we have some new professional members joining Council. The provincial government has also made an appointment to Council of a new Public member. We provide clarification of when a “Mandatory Report” to the College is required, and there are updates on recent staff changes at the College.
This issue’s Feature article will provide you with some insight into the practice environment for your colleagues in a distant part of northeastern Ontario.
Enjoy ex·press issue 2!
As a result of recent professional member elections for three-year terms, the following individuals have joined Council as representatives from their respective Districts:
District 2 (Toronto and area):
Vicky Papaioannou (AUD) (re-elected to a third term)
Yvonne Windham (SLP) (elected for first term)
District 5 (Northeastern Ontario):
Jennifer Anderson (AUD) (elected for first term)
As well, the provincial government re-appointed public member Ferne Dezenhouse of Toronto for a final one-year term and has just appointed Vince Bucci of Brantford for an initial three-year term on Council. This brings Council up to its maximum total of 18 members.
At its meeting in June, Council noted that the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA) was formally submitting to the government, its proposed changes in professional scopes of practice for Audiologists and Speech-Language pathologists. These submissions can be found at www.osla.on.ca. The College expects to be consulted soon by the Ministry of Health and Long-Term Care on the proposed changes.
Council was informed that CASLPO’s sister college in Manitoba, CASLPM, will be increasing its annual fees from $735 per member to $935.
The CASLPO Council held annual elections in June for positions on its Executive Committee. The following were elected or re-elected:
President: Scott Whyte (Public Member)
Vice President (AUD): Deb Zelisko
Vice President (SLP): Bob Kroll
Member at Large: Véronique Vaillancourt (AUD)
Member at Large: Judy Rowlands (SLP)
Member at Large: Shari Wilson (Public Member)
Scott Whyte thanked members for placing their trust in him once again and for all their hard work and dedication over the past very challenging year.
The Council of CASLPO, which governs the College, meets quarterly in open session throughout the year. A schedule of meetings is posted on the College website, as well as meeting agendas and materials. Any member of the College and the public are welcome to observe the proceedings. Meetings usually take place on Fridays beginning a 9:30am and ending at 4:00pm.
There have been a number of staff changes to the College as follows:
Camille Prashad has left the College staff after seven years in the position of Program Assistant (Registration Services). Many members likely had contact with Camille over the years in her busy portfolio. The College thanks her and wishes her well. Supporting this area now is Jessica Laforet.
After three years as Director of Professional Conduct and General Counsel, Melisse Willems has left the staff of the College to become the new Registrar at the College of Dietitians of Ontario. This is an exciting new opportunity for Melisse, and we extend both our appreciation for her services and congratulations on her new role.
Replacing Melisse as Director is Courtney Campbell. Courtney is a lawyer and comes to CASLPO from the Ontario College of Pharmacists.
The Records Regulation, 2015 has been approved by the provincial government and is now in effect. This new regulation replaces the previously posted Proposed Records Regulation, 2011.
The new Records Regulation, 2015 is essentially the same as the previously posted version. The new regulation requires each member to:
- Ensure that his or her records are updated, maintained, retained and disclosed in accordance with the regulation;
- Maintain certain types of records, e.g., patient, financial and equipment service records;
- Comply with specific content requirements for each type of record;
- Retain their records for specified time periods (10 years past the last professional contact, unless the patient is under 18 years old at the time of the last professional contact, in which case the record is retained for 10 years past the date on which they turn 18) ; and
- Take appropriate steps respecting records on the closure of his or her practice.
You will note some changes in wording and layout, which are intended to add clarity. However, if you have any questions as you apply the regulation to your record keeping practices, please contact us at: firstname.lastname@example.org / 416-975-5347 / 1-800-993-9459
What Might Clinic Regulation Mean for Audiologists and Speech-Language Pathologists?
Ontarians receive healthcare services in a variety of settings, including hospitals, clinics, and long-term care facilities. Some of these settings, such as hospitals and long term care facilities, are governed by legislation holding them accountable for their operations. Certain types of clinics are also regulated, such as pharmacies and some medical and dental clinics. However, there are many clinics that are currently not subject to oversight.
Health regulatory colleges have a mandate to protect the public. However, achieving that mandate effectively can be a challenge in a system regulating only individual professionals, rather than their workplaces.
CASLPO has been working with a group of some 15 other health regulatory colleges, exploring whether a new model for regulating clinics would strengthen public protection and improve our healthcare system.
While many clinics operate always in the patients’ best interest, an increasing number of troubling cases across many professions are coming to light in the media and elsewhere. A model to hold these clinics accountable does not currently exist.
In our view, clinic regulation would increase transparency by providing a Public Register of clinics, holding clinic owners accountable for acting in the best interest of the public, and establishing safeguards against fraud and other inappropriate business practices.
How Would Clinic Regulation Improve Your Ability To Meet Your Obligations?
In the proposed model, those who work in a clinic could expect that:
- Billing would accurately reflect the services provided;
- Safeguards would be in place to prevent your credentials from being misused by others without your knowledge; and
- Clinics would maintain adequate records for patients, and you would have appropriate access to those records to facilitate care.
If you have concerns about practices at the clinic, you would be able to notify the regulator without fear of reprisal.
It will ultimately be up to the Government of Ontario to decide whether to establish a clinic regulation framework. While government did not ask the group of Colleges to explore clinic regulation, we are keeping them updated on our work.
To help us explore the viability of a clinic regulation model in Ontario, we must hear your thoughts. During formal consultations this fall and winter, we will be seeking views from members, patients, other health professionals, and businesses.
The clinic regulation model you will read about is very preliminary and drafted for the purpose of the consultations.
So stay tuned, as your feedback will help us refine and improve a potential model for enhancing public protection and providing better health care to all Ontarians.
Members Comment on Proposed College Transparency By-Laws
By Brian O’Riordan
Over the summer months, hundreds of members took the time to respond to the College’s proposed changes in the By-Laws making more information publicly available concerning members, specifically respecting Registration – related information, certain orders issued by the Inquiries, Complaints and Reports Committee and more timely posting of already publicly-mandated disclosures concerning Discipline hearings and decisions.
Feedback was also solicited from the public and stakeholder associations.
The College extends its very sincere appreciation to all those who took the time to comment and complete the survey. The detailed feedback will, in the interest of transparency, be posted soon, on the College’s website.
Many members suggested that a set of public criteria be developed to guide the Registrar’s decision–making respecting making certain relevant member information publicly available involving criminal charges, convictions and bail conditions. This is a very useful suggestion and will be seriously considered as part of the analysis of the feedback received. The College Council will carefully review all feedback before making any final decisions regarding the proposed Transparency By-Law changes.
Across all health care regulatory Colleges, any information made available to the public concerning a member must take place within the context of the College being able to carry out its mandate to provide firm assurance to the public that the self-regulated members registered by the College are competent and are capable of providing safe and ethical care.
Transparency has now been embedded as one of the pillars of governance in the regulatory world and practice environment.
CASLPO Transparency By-Law changes will likely take effect early in 2016.
For more information, see the Transparency area on the College website.
Using e-mail communications with patients: safety versus convenience.
Developing a good working relationship with patients and their families is an integral part of effective and patient-centered intervention. The vehicle of communication that suits many patients and families is frequently e-mail. But how safe is the collection and disclosure of personal health information via e-mail?
CASLPO’s Practice Advice Program has received many inquiries from the membership regarding this topic, so we have laid out some considerations to help you decide when to use this form of communication.
Consider three factors when determining the use of e-mail with your patients and families:
1) Ensure that you obtain and document knowledgeable consent from the patient or families to use e-mail
2) Consider the risk of harm regarding the content of information being disclosed via e-mail
3) Use technologies to help mitigate the risk of harm
1) Knowledgeable Consent
Before you discuss consent, confirm with your employer if they have any restrictions on the use of e-mail as a means of communication with patients.
There are two forms of consent to consider in this situation. The first is the legal consent for the collection, use and disclosure of personal health information. According to the Personal Health Information Protection Act, 2004 (PHIPA), knowledgeable consent is defined as:
(5) A consent to the collection, use or disclosure of personal health information about an individual is knowledgeable if it is reasonable in the circumstances to believe that the individual knows,
(a) the purposes of the collection, use or disclosure, as the case may be; and
(b) that the individual may give or withhold consent. 2004, c. 3, Sched. A, s. 18 (5).
PHIPA also requires you, as health information custodians, to take reasonable steps to ensure that personal health information in your custody or control is:
12. (1) protected against theft, loss and unauthorized use or disclosure and to ensure that the records containing the information are protected against unauthorized copying, modification or disposal. 2004, c. 3, Sched. A, s. 12 (1).
Consequently, the second form of consent concerns the giving of permission for health information to be transferred electronically via e-mail. The patient or substitute decision maker (SDM) must be ‘knowledgeable’ about all of the risks and factors involved in using this form of communication before they give their permission or consent.
Ensuring that the patient or SDM is fully ‘knowledgeable’ will require some work on your part. If you are using an employer’s or a third party’s e-mail system, these parties may have the right to access and/or audit these communications. This information should be disclosed to your patients.
Second, explore all strategies, including liaising with your IT department if you have one, to make your email account as secure as possible. Discuss with the patient or family the steps you will be taking to keep the electronic transfer of personal information confidential and secure, and ask what they are going to do at their end. Talk about the potential risks of a breach such as viruses, hacking, loss of a portable device etc.
When discussing consent, consider who else might be involved in e-mail communications: for example, other family members such as a spouse, supervised support personnel and third parties, for example, doctors, teachers, and relevant professionals. We recommend that you document consent to communicate via e-mail for all of the various individuals
Finally, discuss and document the different types of information to be disclosed via e-mail. Please see below.
2) Content of health Information
You should always consider the risk of harm of a privacy breach when e-mailing patients and families. The mere fact that you, as an audiologist (AUD) or speech language pathologist (SLP), are associated with a patient is personal health information. Some health information is generally considered low risk, for example, scheduling an appointment or confirming a cancelation. However, the consequences of a privacy breach for reports containing sensitive medical information can be profound.
Have a conversation with your patient or SDM, outlining the different types of information that can be communicated from arranging appointments, asking and answering questions, giving therapy session updates, homework/carryover assignments, to assessment, progress and/or discharge reports. Establish with the patient or SDM what information can be communicated by e-mail and document the decision in the patient record. Both you as a clinician and the patient or family will have different comfort levels regarding content of e-mails.
3) Mitigate risk
Technology offers us great convenience for accessing information and communication. However, as a regulated health professional, you must adopt all reasonable safeguards to protect personal health information under your control.
Your work e-mail may be accessed from a variety of devices: smart phones, tablets, laptops and desktop computers. Make sure that all devices are password protected. Many devices allow the creation of a seven digit password which has a higher degree of security. Additionally, ensure that access to your work e-mail account is also password protected - do not share your passwords… ever!
If you have a portable device make sure that it is connected to the ‘cloud’ and activate “find my phone/i-Pad”. If you are in the unfortunate position of having a device stolen, you can access the cloud and ‘wipe’ all data, including e-mail accounts, from your phone or tablet thus protecting patient personal health information. If you have an android device there are various ‘apps’ that carry out the same function. With both systems you can still access the e-mail account from another device.
Correct e-mail addresses
Ask the patient or SDM to inform you immediately if they change their e-mail address so that health information is not sent to a site that is no longer accessed by the patient. When you e-mail your patient or family, check the e-mail address very carefully to make sure it is correct. Examine the ‘To’, ‘Cc’ and ‘Bcc’ boxes to ensure that you are not inadvertently sending the e-mail to a third party. If you inadvertently send information to the wrong person recall the e-mail immediately.
Ontario’s Information and Privacy Commission has adopted a new slogan for electronic communications, “Encrypt by Default”. Meet with your IT department or if you are in private practice consider meeting with an IT consultant to discuss software that encrypts both e-mail messages and attached documents including PDF formats. However, encryption is only truly effective as a security method when it is a two way process. You may send an encrypted report via e-mail, but then the patient or family may respond and send you questions regarding the content of the report in an unencrypted e-mail. To mitigate this risk you could send the encrypted report and ask the parent to call you with any questions, or minimally ensure that the patient is aware of the risks of responding with emails containing personal health information.
Frequently Asked Questions
I work with a child who has a profound hearing loss, is bilaterally aided and about to enter school. The child’s parents are separated, and if one parent brings the child for an appointment the other parent wants an update via e-mail. Can I send the information to both parents via e-mail, even though the child lives with one parent?
There are two questions here; can I use e-mail and can both parents receive information when they are separated? Yes, you can send information via e-mail as long as you discussed and documented knowledgeable consent from both parents. Consent can be obtained in person or over the phone and must be documented in the patient record. The second issue concerns Parents’ rights under the Children’s Law Reform Act (1990) and the Divorce Act (1985) to receive information. Even a parent who does not have custody of the child (access parent) has the right to receive information regarding their child’s healthcare. However, if there is a court order prohibiting one parent from receiving information, that order must be fully respected. Ask the parents if there are any court orders pertaining to the disclosure of information.
We work in a busy Rehab Centre and use support personnel to run different rehab groups. Is it alright if support personnel e-mail patients and families? Generally they e-mail information about the particular group and give updates and tips to families.
Again, consider the three factors: consent, risk of harm and mitigating risk.
You, as the regulated health professional, are responsible for the clinical care provided to the patient. It is your responsibility to ensure that the patient consented to participate in the group being run by the support personnel and that knowledgeable consent to the use of e-mail as a means of disclosing personal health information has been obtained and documented. You are also responsible for adequate supervision of the care provided by support personnel which includes reviewing information provided to patients and families and e-mail communications.
I am working in a difficult situation with regard to a child’s mother. She is in a ‘battle’ with the School Board regarding classroom support for her child, and wants to use my assessment report as part of her submission. I was recently contacted by the mother asking me to change the content of my report to show that her child was not managing in the classroom. I explained that this was not possible. She has now asked me to send her a copy of my report via e-mail. I have real concerns that if I e-mail my report it might be changed.
You are not required to send the mother the report via e-mail. You can offer to send it to her by mail, fax or arrange to meet her at the child’s school. PHIPA outlines the requirements for disclosing personal health information when requested by the patient or substitute decision maker, it does not stipulate the vehicle of communication.
Alternatively you can send the report in a PDF format which cannot be altered. There is now software available which allows you to encrypt PDF documents.
How do we document e-mail communications with patients and families? Does CASLPO want us to print out all e-mail exchanges and keep them in the patient record?
I work for an organization which uses electronic charting – how do I document e-mail communications?
The CASLPO Records Regulation (2015) requires you to maintain a record that includes:
32. (2) 2. The date and purpose of each professional contact with the patient and whether the contact was made in person, by telephone or electronically.
How this is achieved is up to you, you can document a summary of the email communication in the patient record or you may print and keep an e-mail, especially if it is important to retain a verbatim record. If you work for an organization which uses electronic charting, speak to the Health Records department and discuss what should be done with printed copies of e-mails.
CASLPO has resources for you
Visit our website www.caslpo.com
Practice Advice Articles including:
Documentation sections in Practice Standards and Guidelines
Practice Advice Team
Please contact one of us if you have any further questions.
Alexandra Carling-Rowland, Director of Professional Practice and Quality Assurance
Jodi Ostroff, Coordinator of the Audiology Professional Practice Program; English/French-language
Sarah Chapman-Jay, Speech Language Pathology Practice Advisor; English-language
David Beattie, Speech Language Pathology Practice Advisor, French-language
CASLPO does not provide legal advice. Also, Practice Advice is provided in response to specific inquiries and may not be relevant in all circumstances. Finally, the Practice Advice Program is intended to support but not replace professional judgment.
2015/2016 REGISTRATION RENEWAL REMINDER
By Colleen Myrie
Director, Registration Services
Congratulations to those members who have successfully completed their online renewal ahead of the October 1st (midnight) deadline!
If you have not completed your online registration renewal, you must do so before midnight on Thursday October 1st 2015. Don’t wait until the last minute. Click here to renew now.
After midnight on October 1st, a 20% late fee will be added to your payment.
We have the following support options:
Continuous Learning Activity Credits, CLACs:
“What Counts as a CLAC and how do I document them?”
By Alexandra Carling Rowland, Ph.D., Director of Professional Practice and Quality Assurance
The College continually reviews the Quality Assurance (QA) Program to ensure that it is current, relevant and effective for you and your learning needs. This article seeks to answer some of the questions we receive about Continuous Learning Activity Credits (CLACs), and how to document them on your Self-Assessment Tool (SAT).
Continuous Learning Principles
The CLAC section of the QA program is based on principles derived from the Adult Learning and Continuing Professional Development literature. Professional development is enhanced when it is:
- Self-directed: you decide what you need to learn
- Goal oriented: increases the likelihood of changing behaviour
- Occurs in different environments with a variety of activities
- Interactive: peer discussion is especially effective
- Evaluated: you determine if the learning has had an impact on your practice
- Evaluated externally: especially when identifying areas in need of development
The first two points illustrate the value of self-directed and goal oriented learning. This is why you are asked to obtain CLACs to help you meet Learning Goals that you have developed yourself.
We have included the constructs of learning occurring in different environments and interactive peer discussion by opening up CLAC opportunities, for example:
Speech Language Pathology
Finally, every year when you are completing your Self-Assessment Tool (SAT), you can take a moment to evaluate your learning to determine whether or not the learning has had an impact on your practice and if you have met your Learning Goal.
Quick CLAC FACTS
- You must obtain at least 15 CLACs for each calendar year
- CLACs must relate to one of your Learning Goals
- One hour’s learning activity equals one CLAC
- You can claim in .25 increments; if you read an article for 30 minutes, claim 0.5 CLACs
- CLACs must relate to one of your Learning Goals
- There are two CLAC categories, Group Learning and Independent Learning.
- There are no limits on the number of CLACs for either category
- You can acquire more than 15 CLACs in one year, but cannot carryover extra CLACs from one year to the next
This is not an exhaustive list. Any type of goal-directed learning that involves group participation or independent study that helps you to meet your Learning Goal can count.
Group Learning Activities
Independent Learning Activities
How to document your CLACs
- On your SAT click on ‘Learning Goals’ and click on the Learning Goal for which you have earned CLACs.
- You will be sent to the Goal Writing Page for that goal.
- Below your Goal you will see CLAC Detail, click on ‘Add New Activity’ which is on the bottom left hand side of the page.
- Write a summary of your learning activity in the Learning Activity Summary box. Be sure to include details about your learning activity such as the title, presenter and date of the activity you attended or the name and author of the article you read etc.
- Add the number of CLAC hours. If you spent 90 minutes on your learning activity, then document 1.5 CLACs.
- From the pull-down menu, select either ‘Group Learning’ or ‘Independent Learning’.
- If you wish, you can upload information about your CLACs, for example a conference brochure, course outline or an article. This is optional, unless you are selected for a peer assessment.
Further Learning Opportunities
If a learning opportunity arises that applies to your role, responsibility, area of research or practice, but does not relate to one of your current Learning Goals, develop another Learning Goal and document the CLACs.
Supervision of Students and CLACs
Some of you may be supervising speech-language pathology, audiology or support personnel students. You are able to collect CLACs as long as it entails learning on your part and is connected to one of your Learning Goals.
Learning Goal: To keep current with cochlear implant technology in order to support student learning in the clinic environment.
Learning Goal: To learn more about effective feedback methods to ensure a positive supervisory relationship to promote learning.
1.0 Read article ‘Cochlear Implants’ American Academy of Otolaryngology (2015) – Aug 14th Independent Learning.
3.5 Read initial 2 chapters from How to Give Effective Feedback to Your Students by Susan M. Brookhar (2008) – March 12th Independent Learning.
Leave of Absence and CLACs
If you are on a parental leave, or a leave for any other reason, and you chose to remain a General or Academic member, you are still required to develop your learning goals and collect 15 CLACs. While you are on leave develop a Learning Goal that applies to your role or responsibilities, but that you can meet, for example:
Learning Goal: To keep current with College regulations and standards to ensure that the information I provide staff upon my return is up to date, ethical and complies with legislation and regulations.
1.5 Read September edition of ex.press*
0.5 Reviewed “What’s New” section on CASLPO Website*
1.0 Read CASLPO Forum power point slides*
*Don't forget to add the date
Activities NOT considered to be CLACs
- Learning about your agency’s new data collection system
- Setting up an office
- Marketing or writing advertisements
- Teaching volunteers to help with record management and filing
- Administrative staff meetings that do not involve an education component
- Personal development activities (e.g. horseback riding, yoga)
Note: Members may NOT claim CLACs for activities which are part of a remediation order by the College, such as a Specified Continuing Education and Remediation Program (SCERP) required by the Inquiries Complaints and Reports Committee (ICRC) or the Quality Assurance Committee (QAC). SCERPs could include courses or other learning activities.
For further information or questions about CLACs please contact me at CASLPO:
Alex Carling Rowland, Director of Professional Practice and Quality Assurance,
Tel: 416 686 8298 or toll free 1800 993 9459 extension 226
NEW CASLPO E-FORUMS: YOUR OPPORTUNITY TO DISCUSS SPECIFIC PRACTICE ISSUES
By Alexandra Carling Rowland, Ph.D., Director of Professional Practice and Quality Assurance
We are excited to introduce our first, new CASLPO E-Forums. Webinar technology will enable us to interact with you in real time. E-Forums will focus on specific practice areas, incorporating open discussion to address your issues as they relate to the College. After registering, send us your questions and issues and join College staff via webinar. We have already identified ‘hot topics’ from our Practice Advice Program.
Watch your ‘inbox’ for information on how to register and join the E-Forums.
Thursday October 22nd 2015, 12.00 – 1.30pm
PRIVATE PRACTICE ISSUES: SPEECH LANGUAGE PATHOLOGY
- Conflict of Interest
- Concurrent Intervention
- Records and access to the patient record
- Working with support personnel
- Incorporation, title of company and Liability Insurance
Thursday October 29th 2015, 12.00 – 1.30pm
PRIVATE PRACTICE ISSUES: AUDIOLOGY
- Conflict of Interest
- Prescription versus Assistive Devices Program
- Records and access to the patient record
- Working with unregulated professionals
- Internet sales of hearing aids
- Incorporation, title of company and Liability Insurance
We look forward to engaging in productive discussions with you.
We have thoroughly enjoyed meeting members in Toronto, Kitchener and North Bay and discussing College issues that are important to you. We are looking forward to visiting Kingston for our final Forum in October.
Complaints and Hearings
Mandatory Reporting of Terminations and Resignations
Oftentimes, there is confusion by employers as well as members as to why and when mandatory reports of terminations or resignations must be reported to the College. The following answers to the most common questions will assist both employers as well as members in understanding professional reporting obligations.
1. What terminations must be reported to the College?
Under the Regulated Health Professions Act (RHPA), a person must report the following to the College:
- A member is terminated for reasons of professional misconduct, incompetence or incapacity;
- A member’s privileges are revoked, suspended or restricted for reasons of professional misconduct, incompetence or incapacity;
- A partnership, health profession corporation or association with a member is dissolved for reasons of professional misconduct, incompetence or incapacity.
The RHPA further sets out what constitutes professional misconduct, incompetence or incapacity.
2. What must be reported to the College if a person intended to terminate a member’s employment or to revoke the member’s privileges for reasons of professional misconduct, incompetence or incapacity, however the member resigned or voluntarily relinquished his or her privileges?
In these circumstances, the RHPA requires the resignation or relinquishment to be reported to the College.
3. When must a person report the termination or resignation to the College?
A mandatory report must be filed with the College within 30 days of the termination or resignation.
4. What information should the report contain?
The report should contain:
- The name and contact information of the person who is filing the report;
- The name and the registration number of the member who is the subject of the report;
- A description of the concerns that led to the filing of the report and any supporting documentation.
5. What happens once the College receives a report of termination or resignation?
Once the College receives a report of termination or resignation, the Registrar will determine whether further investigation is required. The investigation of mandatory reports is overseen by the Inquiries, Complaints and Reports Committee of the College.
For more detailed information on the subject, please contact the Director of Professional
Conduct at 416-975-5347 x 221.
A Member’s Story: Practicing in the Northeast—Water Taxis, Whales and Ice Roads
By Sherry Hinman
Usually when clinicians talk about adjusting their schedules to suit their clients’ needs, they’re not thinking about the biannual goose hunt. But if you’re practicing in the northeast of Ontario, you’ll need to keep it in mind.
Lorna Hrbolich is a speech-language pathologist who has been working in the Preschool Speech and Language Program at the Timmins Branch office of the Porcupine Health Unit since 2009. The office has four speech pathologists and one assistant. There is also an office in Cochrane, which provides services to the Cochrane North region, with one full-time speech pathologist and two part-time assistants.
While the populations in the towns Lorna services are small, the territory is vast—approximately 54,000 square miles. At her office in Timmins, she sees preschool children with speech and language disorders such as apraxia, autism, language delay and stuttering.
The challenge comes when providing services to children in Moose Factory and Moosonee, as she travels there only three times a year. Lorna carries a caseload of about 40 to 45 children there; add to that another 5 who travel from northern coastal communities. Trips to Moose Factory and Moosonee are for 3-1/2 days, and she and another speech pathologist from her office, Lauren Campbell, each see about 6 or 7 children per day, or about 21 children each, on a given trip.
Fulfilling the needs of so many children over such a short period of time takes creativity and collaboration. Most of the children are seen in daycare or at school, and there is space set aside for Lorna and Lauren to work. Daycare workers and resource teachers then put into practice their recommendations. The speech pathologists also provide home programming.
Lorna says she could measure the increasing importance people placed on speech/language services over the years by the number of children who attended their sessions. “In the beginning, if I had 20 or 21 kids scheduled, 14 or 15 attended. Now I book 17 and see 21.”
Extra funding needed for Lauren’s position was secured (and is renewed based on proposal submission on an annual basis) through Best Start Network, which is part of the Ontario Ministry of Children and Youth Services’ Early Child Development Aboriginal Planning funding.
Covering a Vast Territory
Lorna’s territory covers Timmins and Matheson, but it also includes Moosonee and Moose Factory, which are over 300 kilometres to the north of Timmins and 850 kilometres north of Toronto. At the last census in 2011, Moosonee had a population of 1,725, though the municipal government estimate is 3,500. Moose Factory is a community on Moose Factory Island, near the mouth of the Moose River; its last population count was 2,458.
Moosonee—the “Gateway to the Arctic”—is approximately 85% Cree, but the children speak English as their first language. Cree is taught in schools as a subject, and families speak a mix of the two languages at home. Moose Factory was the first English-speaking settlement in Ontario and is also mainly Cree. Being this far north affects travel to the area, which is limited to train from Cochrane or plane from Timmons.
Deferring to Mother Nature
Of course, weather is a major player in daily life here. Lorna recalls one time when the plane wasn’t able to fly them out of the area and back to Timmins because of a storm. “We travel here by plane,” she says. “Except not when the Moose River freezes or thaws.”
Mode of travel between Moosonee and Moose Factory depends on the season. In summer, people get across by water taxi—basically, a canoe with a motor—along the Moose River. In winter, an ice road—a temporary road carved out of the ice and snow—bridges the 10-minute span. During freeze-up and spring breakup, helicopters are used to travel between the communities. Mother Nature brings one more surprise—Moose River is salt water and it has a tide. “On a windy day, the tide shifts,” Lorna explains, “and the water can come up on the ice.” Sometimes when this happens, they have to temporarily close the road.
First Nations Coastal Communities: Fort Albany, Kashechewan, Attawapiskat and Peawanuck
Lorna is also responsible for four First Nations coastal communities that are further north, although families must travel south to Moosonee/Moose Factory for her to see them. These communities are accessible only by air or ice road.
For a sense of the trip families must make, here are some of the demographics of these communities:
- Fort Albany (pop. 2,031): on James Bay, 125 km north of Moosonee
- Kashechewan (pop. 1,800): about 130 km north of Moosonee, on James Bay
- Attawapiskat (pop. 1,929): on James Bay, approximately 225 km north of Moosonee
- Peawanuck (pop. 237): 525 km north of Moosonee, on Hudson Bay
Creative Service Delivery
Lorna and Lauren also maximize their visits by having daycare and school staff attend the sessions. For example, a junior kindergarten teacher might ask an educational assistant to attend. Family usually attend the sessions as well, either a parent or grandparent. Because the schools know ahead of time when the speech pathologists will be there, they might hire a supply teacher to cover the class so that the teacher can attend.
Lorna treats a few clients by Skype, children needing therapy for stuttering, for example. And some families from the coastal communities are seen when they travel to Timmins for shopping or a hockey game.
Despite their accomplishments, Lorna says she worries that the infrequency of visits impacts the services they can offer. “It’s a challenge to provide intensive therapy when you’re only there three times a year.” Lorna says there is a special needs strategy in the works, and she is hoping this will improve services for all. The Cochrane Temiskaming Children’s Treatment Centre also provides speech pathology services on a regular basis to Moosonee and Moose Factory but not to the coastal communities.
Cherishing What is Special
But there are definite advantages to providing services in such a small place, especially if you come back a few times a year. “So many people come from all over,” Lorna says. “People know who you are and why you’re there. You develop a rapport and a trust relationship with the people in the community.”
“One time at the hotel, the phones were down, and I couldn’t call a cab to take me to my appointment. So one of the waitresses drove me there. And the people from the area give you tips, like, make sure you ask for a river view at the hotel.”
The winters are long and cold, and there are swarms of flies and mosquitos in the summer. Even spring brings its challenges—everyone wears boots because there’s mud everywhere. But the land is beautiful. “I can remember one sunny day,” Lorna recalls. “We took the river taxi along Moose River, arrived at Moose Factory, and climbed the steep stairs to Eco Lodge, exhausted. Two young girls called out to me, ‘Did you see the whale?’ I turned around and, right behind me, maybe 6 or 8 feet away from where I had got off the boat, was a beluga whale.”
While she wishes they could do more, and acknowledges the challenges the geography poses, Lorna admires and respects the people and the beauty of the land. “I enjoy it. It’s difficult and challenging, but I’m happy about the links we’ve made and the relationships we’ve built.” She believes they are making a difference.